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Tuesday, February 26, 2008

The Illusion of Midwifery in Saskatchewan; written by Lisa Wass

There are good reasons to celebrate the recent regulation and funding for midwifery services in Saskatchewan. Acknowledgement by our provincial health care system that homebirth is safe and that midwifery is a credible and necessary profession has been a long time coming.

For many years, health care professionals who considered midwifery unscientific and irresponsible have mistreated those who have chosen the midwifery model of care. As a consequence, mothers and babies have been very limited in their birth choices for decades. Truth be known, midwifery care is a scientifically sound, natural approach to normal pregnancy, birth and early parenting. It provides a standard of care that cannot be duplicated by any other system; indeed, midwives are specialists in normal birth.

The greater concern now is that the government has left it up to each individual health region to hire midwives and develop delivery systems. Saskatoon and Regina are set to hire midwives, but are having trouble recruiting the minimum numbers needed—a news release erroneously identified that each city had already recruited four midwives. In fact, no hiring has been verified.

Furthermore, there is a national shortage of midwives. Even Manitoba (whose midwifery system Saskatchewan is modeled after) has yet to meet the numbers required since its implementation in 2003. It is conceivable that, while highly desirable, funded midwifery care will not be readily accessible in Saskatchewan for perhaps more than a decade.

Midwives hired by Saskatchewan health regions will also be subject to strict restrictions on their home birth practice. In urban areas such as Saskatoon, midwives will not be permitted to serve women in a home birth capacity outside of the city limits. This is a rural province; more than half of all midwifery clients in Saskatchewan reside in rural areas.

There is room in the legislation for independent midwives to continue to work outside of the regional health districts. However, the added exorbitant cost of liability insurance, coupled with the fact that Saskatchewan health has chosen not to fund private practice, will be yet another limiting factor to accessing midwifery care. Independent midwives will need to charge more than double their currents rates just to break even under the new regulations. So, while the provincial government should be applauded for funding midwifery, effectively half of the current consumer base has just lost access to the birth services they hold dear.

Experience from other provinces, like B.C.—which has taken this same funding and jurisdiction route—would indicate that Saskatchewan can expect an increase in the number of unregulated midwives and ‘unassisted’ home births, as women scramble for options outside of hospital settings to bring their children into the world. Without consumer outcry for more flexible implementation and local midwifery education programs to combat the shortage, accessible and funded midwifery care in Saskatchewan is merely an illusion.